Practice of deep venous thrombosis prophylaxis and its incidence in patients undergoing gastrointestinal and hepatobiliary surgery: a single-center, retrospective study

Background: Recent studies from Asia have reported a wide variation in the incidence of deep vein thrombosis (DVT), ranging from 5% to 50% in patients undergoing major abdominal surgery. However, data specific to the Nepalese population remains unavailable. Aims: To evaluate current thromboprophylaxis practices and determine the incidence of DVT in Nepalese adults undergoing gastrointestinal and hepatobiliary surgery. Methods: This retrospective study included adult patients who underwent major gastrointestinal or hepatobiliary surgery at a tertiary referral center between October 2021 and April 2024. Demographic and surgical variables were collected. Primary outcomes included the use of thromboprophylaxis and incidence of DVT; secondary outcomes included DVT location, timing of diagnosis relative to surgery, and in-hospital mortality. Results: A total of 1,530 patients met the inclusion criteria. Pharmacologic prophylaxis was administered in only 3.6% of cases. The incidence of DVT was 0.26% ( n = 4), with all cases involving the lower extremities and diagnosed in the postoperative period. Among the patients who developed DVT, 75% had underlying malignancy and hypothyroidism, and all had undergone prolonged surgeries (>3 hours). None had received thromboprophylaxis. Conclusions: There are no established institutional guidelines for DVT prophylaxis or screening in our center. Despite the limited use of thromboprophylaxis, the incidence of DVT was significantly lower than in Western populations and comparable to other South Asian cohorts. These findings suggest against the universal prophylaxis guidelines from Western settings, and that prophylaxis could be more appropriately targeted toward high-risk individuals.